Thursday, July 2, 2015

Our equity analysts published Hidden Gem - Oct 2011 research report and shared it with all Hidden Gems members. Hidden Gem stock of Oct'11 was Kovai Medical Center & Hospital Ltd and Hidden Gem research report was published on 27th Oct'11 with buy recommendation at average price of Rs. 107.

KMCH stock made its life time high of Rs. 730 today and closed at Rs. 729.50 giving absolute returns of 582% to our members in 44 months, our 7-Bagger stock within period of 4 years.In Mar'15 quarter, net profit of Kovai Medical Center & Hospital rose 32.44% to Rs 9.35 crore against Rs 7.06 crore during the previous quarter ended March 2014. Sales rose 21.62% to Rs 105.25 crore in the quarter ended March 2015 as against Rs 86.54 crore during the previous quarter ended March 2014. For the full year,net profit rose 63.15% to Rs 38.70 crore in the year ended March 2015 as against Rs 23.72 crore during the previous year ended March 2014. Sales rose 20.18% to Rs 401.44 crore in the year ended March 2015 as against Rs 334.02 crore during the previous year ended March 2014.Company has good consistent profit growth of 27% over 5 years. Moreover, company has a good return on equity (ROE) of 26% during last 3 years. We suggested our members to continue holding KMCH with maximum allocation of 3% in June 2014. Since our update on KMPH, stock price has appreciated by whopping 300% during last 12 months.

Below is the summary of Kovai Medical Center & Hospital Ltd published in our Hidden Gem research report - Oct'11.

Company Background

Kovai Medical Center and Hospital is 700-bed multi-disciplinary super-specialty hospital located in the NH 47, opposite to Airport, Coimbatore. The hospital has more than 50 medical disciplines managed by highly qualified and trained full time medical specialists providing round the clock service. Over 1000 in patients and out patients are treated every day at the hospital.

KMCH is located on an 20 acres plot in a serene, clean and hygienic atmosphere. It has a very good ambience. The hospital is equipped with 11 operation theatres, and Super speciality procedures like Open heart surgeries and other Cardiac surgeries, Kidney transplants, Knee replacements, Hip replacements and Complex Neuro surgeries are done regularly at the hospital. Angiograms, Angioplasties, Stenting (Sirolimus stent - A drug eluted stent which has no relapse rate) are being done with good success rate. The hospital also has an excellent facility for providing Emergency and trauma care for treating various emergencies such as Cardiac arrests, Road Traffic Accidents (RTA), Snake bites, severe burn injuries, poisonous case, stab injuries and mass casualities.

KMCH is the only center in south India which has introduced a new technique known as GDC coils and clipping of Brain Aneurysms. KMCH has made a breakthrough in the treatment of Stroke Management and Uterine Fibroids with the latest technique in Interventional procedures. The state-of-the-art Fertility Center at KMCH is well equipped to do the Assisted Conception program like IVF, ICSI to the International standards. Most advanced treatment techniques are adopted here.

KMCH is recognized for organ transplant programmes by the Government of Tamil Nadu. Several Kidney transplants and corneal transplants from live donors and cadavers have been done. KMCH is also recognized by the Tamil Nadu Government to do Heart and Lung transplants.

It has a rural health center at Veeriampalayam to serve the rural community and the under privileged.

Hospital is recognized for Diplomate of National Board (Post Graduate Programmes) in departments like General surgery, Anaesthesiology, Cardiology, Cardiothoracic surgery and Obstetrics & Gynaecology. Hospital is recognized for training doctors in AFRCS programme in General Surgery.

State of the art Cancer treatment facility at KMCH

The state of the art cancer treatment center at the Kovai Medical Center & Hospital is headed by Dr.V.Kannan, a highly reputed radiation oncology specialist in India. He was the chief of radiation oncology services at Hinduja Hospital in Mumbai. Dr Kannan has now taken charge as Director of the KMCH Comprehensive Cancer Center.

KMCH comprehensive cancer center offers radiotherapy, chemotherapy and surgeries for the Cancer patients. It will be of international standard of care in terms of investigations and modern treatments including Radiotherapy.

The new facility is equipped with the latest Linear Accelerator the "Varian Triology with Rapid Arch" offering therapies like SRS, Image Guided Radiation Therapy, Intensity Modulated Radiation Therapy besides routine Radiation therapy. These Radiotherapy facilities at the cancer center of KMCH will match the best in the world that will have provision to perform 4 dimensional CT scan which accurately assess respiratory problems and movement of tumours in order to plan treatment of patients.

Recent Developments (as on 27 Oct'11)

Expansion Plan will increase Revenue & Profitability in FY 2012-13

In the year 2011 KMCH has invested Rs 200 Cr for expansion plans, equipment and providing specialty services. As per the planned expansion by the next year, it will start medical college so as to provide all paramedical courses for post graduation programmes. With the above plan under implementation the loan book has grown to Rs 192 Cr up by 78% on comparison to last year impacting profit margins of the company.

There will be significant rise in revenue and profitability once KMCH turns into a full-fledged medical college & hospital with all medical facilities available inside one campus.

Health Insurance – Another Key Factor for Growth

Insurance service is a potential area for growth with regard to healthcare services. In South India, Tamil Nadu has done well in this area and is on second position, next to Andhra Pradesh. In terms of insurance, both private insurance and government funded insurance schemes have shown rapid growth. Each year, there is 20-30% growth in private insurance claims. The insurance scheme has made a positive impact and effectively reduced the cost of healthcare services. Currently 20-25% of revenue is reported from the Insurance segment which is expected to go around 40-45% in coming years.

Net profit of Kovai Medical Center & Hospital rose 200.00% to Rs 2.43 crore in the quarter ended June 2011 as against Rs 0.81 crore during the previous quarter ended June 2010. Sales rose 38.53% to Rs 51.13 crore in the quarter ended June 2011 as against Rs 36.91 crore during the previous quarter ended June 2010

Net profit of Kovai Medical Center & Hospital rose 51.75% to Rs 3.90 crore in the quarter ended March 2011 as against Rs 2.57 crore during the previous quarter ended March 2010. Sales rose 38.43% to Rs 47.94 crore in the quarter ended March 2011 as against Rs 34.63 crore during the previous quarter ended March 2010.

For the audited full year, net profit rose 4.40% to Rs 12.10 crore in the year ended March 2011 as against Rs 11.59 crore during the previous year ended March 2010. Sales rose 34.27% to Rs 174.64 crore in the year ended March 2011 as against Rs 130.07 crore during the previous year ended March 2010.

Sector Outlook

The Indian healthcare sector is predicted to reach US$ 280 billion by 2020, contributing an expected Gross Domestic Product (GDP) spend of 8 per cent by 2012 from 5.5 per cent in 2009, according to a report by an industry body. Growing population, increasing lifestyle related health issues, cheaper treatment costs, thrust in medical tourism, improving health insurance penetration, increasing disposable income, government initiatives and focus on Public Private Partnership (PPP) models are some of the driving factors for the growth of healthcare sector in India.

Some of the key players in the Indian healthcare industry who are helping in making the sector buyout include Apollo Hospitals Enterprise Ltd., Fortis Healthcare Ltd, Max Hospitals and Aravind Eye Hospitals.

Challenges and Opportunities

Owing to the fact that the healthcare sector is one of the largest service sector industries in India with an estimated revenue of US$ 35 billion, the industry has also emerged as on the of most challenging sectors as well.

 India would require another 1.75 million beds by the end of 2025 to reach a ratio of two beds per 1000 population.

 An additional 0.7 million doctors are needed to reach a doctor population ratio of 1:1000 by 2025.

 Although the health insurance sector is projected to grow to US$3.8 billion, the health insurance penetration rate still has a lot more scope to grow with only 2 per cent of the total population being insured at present.

The government recognised the significant challenges and potential in the sector and provided priority status to healthcare in the Eleventh Five Year Plan. Further, the sector is expected to witness added growth through a well-defined partnership between the government and the private sector.

Government initiatives in the public health sector have recorded some noteworthy successes over time with focus on investments related to better medical infrastructure, rural health facilities etc.

Government Policies

 100 per cent FDI is permitted for health and medical services under the automatic route.

 The National Rural Health Mission (NHRM) had allocated US$ 10.15 billion for the upgradation and capacity enhancement of healthcare facilities.

Moreover, in order to meet revised cost of construction, in March 2010 the Government allocated an additional US$ 1.23 billion for six upcoming AIIMS-like institutes and upgradation of 13 existing Government Medical Colleges.

Meanwhile, the total healthcare infrastructure expenditure is expected to reach US$ 14.2 billion in 2013, registering an increase of 50 per cent as compared to the 2006 figure, according to a report by KPMG.

Major Investments

The sector is undergoing significant changes driven by the continuing phase of rapid economic growth, with emerging markets, such as medical device manufacturers and diagnostic chains attracting increasing amounts of investments.

 Hospitals chain Apollo Hospitals Enterprise Ltd plans to invest around US$ 204.04 million- US$ 226.70 million over the next two years.

 Wockhardt Hospitals plans to invest up to US$ 158.32 million to double its bed capacity to 2,000 by 2013.

 The BCG Group plans to build a multidisciplinary health facility, BCG Health square in Palarivattam in Kochi, Kerala, by August 2011. The company’s long-term plan is to set a 750,000 sq ft health village with an estimated cost of US$ 88.91 million.

 GE Healthcare will invest US$ 50 million to set up more facilities for developing diagnostic services.

 Manipal Hospitals plans to invest US$ 45.23 million in the next three years to double its capacity to 8,000 beds.

PPP Model

Private healthcare is emerging as one of the fasting growing sectors in India, with hospital chains exploring the markets in metros and tier II cities, private players seeking accreditation and developing new healthcare models. Further, the private and public sectors across various states such as Gujarat and Uttarakhand have launched innovative initiatives to attract PPP investments into healthcare.

While the government is exploring potential to establish state-funded healthcare insurance schemes for supporting healthcare delivery for the poorer sections of the population, the corporate segment is catering to the growing need of the general public for quality care. Thus, through a sustainable partnership, development and delivery of low cost, affordable, basic healthcare services, PPP models may help in improving the infrastructure and healthcare provision in the country.

Investment Rationale & Key Developments

 Rural healthcare sector in the country is also witnessing an upsurge. The rural health sector has added around 15,000 health sub-centres and 28,000 nurses and midwives during the last five years, according to the Rural Health Survey Report 2009, released by the Ministry of Health. The number of primary health centres has increased by 84 per cent, taking the number to 20,107, according to the report.

 Indian health insurance market represents one the fastest growing and second largest non-life insurance segment in the country, according to a report by research firm RNCOS. The health insurance premium is expected to grow at a Compound Annual Growth rate (CAGR) of over 25 per cent for the period spanning from 2009-10 to 2013-14, according to the report.

 India’s share in the global medical tourism industry is predicted to be around 3 per cent by the end of 2013, according to a report ‘Booming Medical Tourism in India’ by research firm RNCOS, released in December 2010. The sector is expected to generate around US$ 3 billion in revenues by 2013, with the number of medical tourists to grow at a CAGR of over 19 per cent during 2011-2013 to reach 1.3 million by 2013.

 Indian medical technology industry is expected to reach US$ 14 billion by 2020 from US$ 2.7 billion in 2008, according to a report by PwC and an industry body.

 The country’s first healthcare Special Economic Zone (SEZ), Frontier Mediville, is being set up by Frontier Lifeline Hospital at Elavoor, near Chennai.

 Major healthcare players such as Fortis and Apollo are expanding to tier-II and tier-III cities, along with urban cities, due to substantial demand for high-quality and specialty healthcare services in these cities.

 Healthcare majors such as Apollo, Max Healthcare and Manipal Group are targeting new segments such as primary care and diagnostics. Demographics, health awareness and increasing capacity to spend are the key drivers of the preventive healthcare segment in India.

 Computer-based bio-surveillance projects generating data about diseases and creating databases on healthcare in rural areas are gaining popularity in India with various organisations such as Narayana Hrudayalaya and the Mazumdar Shaw Cancer Centre entering into this sector.

Saral Gyan Recommendation (as on 27th Oct'11)

i) With Investment of Rs 200 Crore for expansion plans, equipment and providing specialty services, KMCH management is looking aggressive and more focused to achieve new milestones going forward. Company offers best treatment using modern facilities and new technologies in south region which distinguish KMCH from other hospitals.

ii) As per the planned expansion by the next year, KMCH will start medical college so as to provide all paramedical courses for post graduation programmes. This will not only add revenues but also improves the profit margins of the company.

iii) The Management holds 47.46% (June 2011 - Increased holding by 1.35% during last one year) equity in the company and is continuously increasing its stake at current valuations which gives confidence of growth prospects in coming quarters.

iv) Stock is available at low valuations, currently trading at a P/E ratio of 9, whereas peer stocks trade at a double digit PE multiple. Moreover, visibility of increased in earnings in FY 2012-13 make KMCH a good buy at current market price for investors who can hold it for period of 18-24 months.

v) On operating profits KMCH has out performed it performance for the quarter ended March 2011. EBIDTA witnessed a growth of 33% on yoy basis and 42% for full year 2011. Margins for the March quarter witnessed the highest ever at 21.6% vs 18.6% when compared for the same quarter last year. On consolidated basis EBIDTA margins stood at 21.2% vs 20%. KMCH’s profitability witnessed pressure mainly due to higher than expected interest cost from Rs 4.84 Crore in 2010 to Rs 11.11 Crore in 2011.

vi) At current market price of Rs 115.70, dividend yield works out to be 1.08%. On equity of Rs. 10.94 crore the estimated annualized EPS for FY 2011-12 & FY 2012-13 works out to Rs. 13.7 and Rs. 18.5 respectively. Book value per share is Rs. 46.38 and at CMP of Rs. 115.70, stock price to book value is 2.49. Currently, the scrip is trading at 8.5X FY 2011-12 and 6.5X FY 2012-13 estimated earnings which seem to be cheap in healthcare space.

Considering growth potential of Indian Hospital Industry, attractive valuations of KMPH and its expansion plans, Saral Gyan Team recommends “BUY” for Kovai Medical Center and Hospital for a target price of Rs. 245 over a period of 18-24 months.

Saral Gyan Capital Services

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